title: [Study of a cohort of patients with Enterococcus spp. Bacteraemia. Risk factors associated to high-level resistance to aminoglycosides].
abstract: OBJECTIVE
  To analyze a cohort of patients with Enterococcus sp. bacteraemia.
  
  
  METHODS
  Retrospective and observational study of a cohort of non-pediatric in-patients with Enterococcus spp. bacteraemia (June 2007-September 2009). Data collection from clinical records was done according to a standard protocol. We analyzed epidemiological, clinical and microbiological data. Treatment with glycopeptides in non allergic patients or in case of betalactam susceptibility (ampicillin) was considered "optimizable".
  
  
  RESULTS
  Three were 106 cases of bacteraemia (2.2/1000 admitted patients; 84% E. faecalis); 83% had an underlying condition; 88% nosocomial or health related cases. Urinary infection was present in 20% and primary bacteraemia in 47%. High level resistance to gentamicin (HLRG) was present in 60%; there was no vancomycin or linezolid resistance. Most frequent empiric treatments were penicillin-betalactamase inhibitor (25%) and glycopeptides (22%). Most frequent definitive treatment was glycopeptides (34%), being "optimized" 21% and 44% of empiric and definitive treatments, respectively. Mortality was 23% (related, 14%). In the multivariate analysis, risk factors associated with HLRG were nosocomial acquired infection (OR 6.083; 95CI% 1.428-25.915) and no-abdominal origin (OR 6.006; 95CI%1.398-25.805). In multivariate analysis, independent risk factors for mortality were: Pitt > 3 (OR 14.405; 95CI%2.236-92.808) and active empiric treatment (OR 8.849; 95CI% 1.101-71.429). Incidence in previous cohort was similar but HLRG rate has increased.
  
  
  CONCLUSIONS
  Risk factors associated with HLRG were nosocomial acquired infection and no-abdominal origin. Risk factors for mortality were initial clinical severity and having received active empiric treatment. HLRG rate has increased.
authors.affiliation: Elisa García-Vázquez, Servicio Medicina Interna-Infecciosas. Hospital Universitario Virgen de la Arrixaca. Murcia, Ctra. Madrid-Cartagena. 30120 El Palmar (Murcia), Spain. elisag@eresmas.net.
authors.forename: Elisa
authors.initials: E
authors.lastname: García-Vázquez
authors.forename: Helena
authors.initials: H
authors.lastname: Albendín
authors.forename: Alicia
authors.initials: A
authors.lastname: Hernández-Torres
authors.forename: Manuel
authors.initials: M
authors.lastname: Canteras
authors.forename: Genoveva
authors.initials: G
authors.lastname: Yagüe
authors.forename: Joaquín
authors.initials: J
authors.lastname: Ruiz
authors.forename: Joaquín
authors.initials: J
authors.lastname: Gómez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000382:microbiology*; D015331:Cohort Studies; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects; D013293:Enterococcus faecalis / Q000187:drug effects; D016984:Enterococcus faecium / Q000187:drug effects; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D013045:Species Specificity; D055815:Young Adult
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D005839:Gentamicins